SPECIALTY CARE AND OTHER PROVIDER ENTITIES
DA TE
ENTITY
FCA ALLEGATIONS
AMOUNT
Urgent care provider network and its management company agreed to pay $22.5 million to resolve FCA allegations that they submitted claims to Medicaid, Medicare and TRICARE for services provided by non-credentialed providers. As part of the settlement, both companies entered into a five-year CIA with HHS-OIG. 87 Pain management company and its owner agreed to pay more than $789,000 to resolve FCA allegations that it improperly billed federal healthcare programs for medically unnecessary urine drug tests. The settlement also resolves allegations that PPM submitted claims to Medicare for specimen validity testing during 2014 and 2015, despite explicit guidance from Medicare beginning in January 2014 stating that such testing should not be separately billed to Medicare. 88
Doctors Care, P.A.; UCI Medical Affiliates of South Carolina, Inc.
4/8/2021
$22.5 million
Preferred Pain Management & Spine Care, P.A. (PPM); Dr. David Spivey
$789,292
4/16/2021
Massachusetts Eye and Ear Infirmary; Massachusetts Eye and Ear Associates, Inc.; Foundation of the Massachusetts Eye and Ear Infirmary, Inc. Anesthesia Services Associates, PLLC d/b/a Comprehensive Pain Specialists (CPS); Dr. Peter B. Kroll; Dr. Steven R. Dickerson; Dr. Gilberto A. Carrero; Dr. Richard J. Muench; Russell S. Smith, D.C.
Provider of services related to eye, ear, nose and throat issues agreed to pay $2.678 million to resolve FCA allegations that it improperly billed Medicare and MassHealth for procedures that were not separately billable from the office visits at which they were performed. 89
$2.678 million
4/20/2021
A now-defunct pain clinic operator, its four majority owners and a former executive agreed to pay more than $4.1 million to resolve intervened FCA allegations that CPS’s pain clinics submitted claims to federal healthcare programs for medically unnecessary and/or non- reimbursable testing and electro-auricular acupuncture. 90
4/21/2021
$4.121 million
Internal medicine practice and its physician operator agreed to pay $300,000 to resolve FCA allegations that they billed Medicare and Medicaid for medically unnecessary Autonomic Nervous System testing. As part of the resolution, the parties entered into a three-year IA with HHS-OIG. 91
Hanora Medical Center, PLLC; Dr. Benjamin C. Udoh
4/28/2021
$300,000
87 https://www.justice.gov/usao-sc/pr/south-carolina-s-largest-urgent-care-provider-and-its-management-company-pay-225-million. 88 https://www.justice.gov/usao-mdnc/pr/winston-salem-nc-pain-management-company-pay-78929295-resolve-allegations-false-claims. 89 https://www.justice.gov/usao-ma/pr/massachusetts-eye-and-ear-agrees-pay-26-million-resolve-false-claims-act-allegations. 90 https://www.justice.gov/usao-mdtn/pr/comprehensive-pain-specialists-and-former-owners-agree-pay-41-million-settle-fraud. 91 https://www.justice.gov/usao-ednc/pr/fayetteville-north-carolina-physician-agrees-pay-30000000-resolve-allegedly-fraudulent.
NOTABLE SETTLEMENTS BASS, BERRY & SIMS | 63
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